Tarsal Tunnel Syndrome & Nerve Entrapments
= Compression of the tibial nerve in the tarsal tunnel
Anatomy:
The tarsal tunnel is formed by the flexor retinaculum behind and distal to the medial malleolus
Contents from ant. to post.: (Tom Dick ANd Harry)
- Tibialis Posterior Tendon
- Flexor Digitorum Longus tendon
- Posterior Tibial artery
- Posterior Tibial Nerve
- Flexor Hallucis Longus tendon
Posterior tibial nerve
- is a branch of the sciatic nerve
- enters the deep posterior compartment of the leg between the two heads of the gastrocnemius.
- It passes deep to the soleus and travels distally between it and the posterior tibialis muscle.
- 3 terminal branches in the tarsal tunnel
- medial plantar nerve - Sensation to the plantar-medial aspect of the foot from the great toe to the medial half of the 4th toe. Motor to the abductor hallucis, flexor brevi & the 1st lumbrical.
- lateral plantar nerve - Sensation to the 4th & 5th rays & toes. Motor to ADQ, the interossei, adductor hallucis, 2nd to 5th lumbricals.
- the calcaneal branch - can be of a variable origin. Provides sensation to the heel pad.
Aetiology:
- An accessory FDL muscle
- Proliferative synovitis - Rheumatoid
- Ganglia
- Varicosities
- Lipomas
- Neurilemomas
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